Provider Demographics
NPI:1447323886
Name:JOHNSON, JEFFREY DON (DPM MS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95421
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0421
Mailing Address - Country:US
Mailing Address - Phone:801-446-4768
Mailing Address - Fax:801-446-1474
Practice Address - Street 1:2052 SPRUCE CREEK LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-2408
Practice Address - Country:US
Practice Address - Phone:801-446-4768
Practice Address - Fax:801-446-1474
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288117-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U48121Medicare UPIN
UT000055781Medicare ID - Type Unspecified